PMID- 25471221
OWN - NLM
STAT- MEDLINE
DCOM- 20150727
LR  - 20220419
IS  - 1475-2840 (Electronic)
IS  - 1475-2840 (Linking)
VI  - 13
DP  - 2014 Dec 4
TI  - Hypertriglyceridemia: a too long unfairly neglected major cardiovascular risk 
      factor.
PG  - 159
LID - 10.1186/s12933-014-0159-y [doi]
LID - 159
AB  - The existence of an independent association between elevated triglyceride (TG) 
      levels, cardiovascular (CV) risk and mortality has been largely controversial. 
      The main difficulty in isolating the effect of hypertriglyceridemia on CV risk is 
      the fact that elevated triglyceride levels are commonly associated with 
      concomitant changes in high density lipoprotein (HDL), low density lipoprotein 
      (LDL) and other lipoproteins. As a result of this problem and in disregard of the 
      real biological role of TG, its significance as a plausible therapeutic target 
      was unfoundedly underestimated for many years. However, taking epidemiological 
      data together, both moderate and severe hypertriglyceridaemia are associated with 
      a substantially increased long term total mortality and CV risk. Plasma TG levels 
      partially reflect the concentration of the triglyceride-carrying lipoproteins 
      (TRL): very low density lipoprotein (VLDL), chylomicrons and their remnants. 
      Furthermore, hypertriglyceridemia commonly leads to reduction in HDL and increase 
      in atherogenic small dense LDL levels. TG may also stimulate atherogenesis by 
      mechanisms, such excessive free fatty acids (FFA) release, production of 
      proinflammatory cytokines, fibrinogen, coagulation factors and impairment of 
      fibrinolysis. Genetic studies strongly support hypertriglyceridemia and high 
      concentrations of TRL as causal risk factors for CV disease. The most common 
      forms of hypertriglyceridemia are related to overweight and sedentary life style, 
      which in turn lead to insulin resistance, metabolic syndrome (MS) and type 2 
      diabetes mellitus (T2DM). Intensive lifestyle therapy is the main initial 
      treatment of hypertriglyceridemia. Statins are a cornerstone of the modern 
      lipids-modifying therapy. If the primary goal is to lower TG levels, fibrates 
      (bezafibrate and fenofibrate for monotherapy, and in combination with statin; 
      gemfibrozil only for monotherapy) could be the preferable drugs. Also ezetimibe 
      has mild positive effects in lowering TG. Initial experience with en 
      ezetimibe/fibrates combination seems promising. The recently released IMPROVE-IT 
      Trial is the first to prove that adding a non-statin drug (ezetimibe) to a statin 
      lowers the risk of future CV events. In conclusion, the classical clinical 
      paradigm of lipids-modifying treatment should be changed and high TG should be 
      recognized as an important target for therapy in their own right. 
      Hypertriglyceridemia should be treated.
FAU - Tenenbaum, Alexander
AU  - Tenenbaum A
AD  - Cardiac Rehabilitation Institute, Sheba Medical Center, 52621, Tel-Hashomer, 
      Israel. altenen@post.tau.ac.il.
AD  - Sackler Faculty of Medicine, Tel-Aviv University, 69978, Tel-Aviv, Israel. 
      altenen@post.tau.ac.il.
AD  - Cardiovascular Diabetology Research Foundation, 58484, Holon, Israel. 
      altenen@post.tau.ac.il.
FAU - Klempfner, Robert
AU  - Klempfner R
AD  - Cardiac Rehabilitation Institute, Sheba Medical Center, 52621, Tel-Hashomer, 
      Israel. Robert.Klempfner@sheba.health.gov.il.
AD  - Sackler Faculty of Medicine, Tel-Aviv University, 69978, Tel-Aviv, Israel. 
      Robert.Klempfner@sheba.health.gov.il.
FAU - Fisman, Enrique Z
AU  - Fisman EZ
AD  - Sackler Faculty of Medicine, Tel-Aviv University, 69978, Tel-Aviv, Israel. 
      zfisman@post.tau.ac.il.
AD  - Cardiovascular Diabetology Research Foundation, 58484, Holon, Israel. 
      zfisman@post.tau.ac.il.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PT  - Review
DEP - 20141204
PL  - England
TA  - Cardiovasc Diabetol
JT  - Cardiovascular diabetology
JID - 101147637
RN  - 0 (Hypolipidemic Agents)
RN  - 97C5T2UQ7J (Cholesterol)
SB  - IM
MH  - Animals
MH  - Cardiovascular Diseases/*blood
MH  - Cholesterol/*blood
MH  - Humans
MH  - Hypertriglyceridemia/*blood/complications
MH  - Hypolipidemic Agents/*therapeutic use
MH  - Insulin Resistance/*physiology
MH  - Risk Factors
PMC - PMC4264548
EDAT- 2014/12/05 06:00
MHDA- 2015/07/28 06:00
PMCR- 2014/12/04
CRDT- 2014/12/05 06:00
PHST- 2014/11/24 00:00 [received]
PHST- 2014/11/25 00:00 [accepted]
PHST- 2014/12/05 06:00 [entrez]
PHST- 2014/12/05 06:00 [pubmed]
PHST- 2015/07/28 06:00 [medline]
PHST- 2014/12/04 00:00 [pmc-release]
AID - s12933-014-0159-y [pii]
AID - 159 [pii]
AID - 10.1186/s12933-014-0159-y [doi]
PST - epublish
SO  - Cardiovasc Diabetol. 2014 Dec 4;13:159. doi: 10.1186/s12933-014-0159-y.